Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Dec 2019
[Update ESC-Guideline: Management of cardiovascular diseases during pregnancy - What is important?]
The treatment of pregnant patients with a cardiovascular disease is a special challenge to deal with. Before getting pregnant all cardiac patients should get medical advice accordingly to their risk profile in the modified World Health Organization classification of maternal cardiovascular risk. This article has the aim to give an overview of the new or changed recommendations of the new ESC-Guideline for the management of cardiovascular diseases during pregnancy.
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In Germany, the group of geriatric patients is the biggest part of all decedents. That is the reason why the medical staff, who is taking care of elderly patients, needs not only curative, rehabilitative and preventive competencies but also palliative skills. ⋯ However, there is no tool for the identification of palliative needs of geriatric inpatients in emergency rooms and in other places in the hospitals. In primary care, the Supportive and Palliative Care Indicators Tool (SPICT) is available for this purpose.
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We report the case within a 22-year-old patient, initially seen because of fatigue, weight loss and discoloration of the skin. A Hashimoto-Thyroditis had been diagnosed a few months prior to the clinical presentation. ⋯ The presented case underlines the importance of focused examinations and diagnostics when dealing with a patient with unspecific symptoms and a pre-existing autoimmune disease. This also applies to patients with a positive family history for autoimmune disorders.
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Dtsch. Med. Wochenschr. · Dec 2019
Historical Article[Natural Science as a Kind of Natural Poetry: A Statement by Christoph Wilhelm Hufeland (1762-1832) Against Natural Philosophical Medicine].
At the turn to the 19th century, medicine in Germany became strongly influenced by the teachings of John Brown, who was a scottish physician. He had advocated a theory which regards and treats disorders as caused by defective or excessive excitation. His teachings were welcomed by natural philosophers like Schelling or Hegel. ⋯ As viewed from today, evidence based medicine eventually established our modern ways for successfully diagnosing and treating disease. However, Hufelands disapproval appears to be still relevant. There are many people that even now advocate alternative ways and who consult quacks, healers etc.
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Dtsch. Med. Wochenschr. · Dec 2019
[Batten down the hatches: CAR T-cells - immuno-oncology meets intensive care medicine].
CAR T-cell treatment has brought a significant benefit for patients with relapsed and refractory lymphoma and even long lasting remissions seem to be possible. Despite the good results CAR T-cell treatment is associated with severe and potentially life-threatening adverse effects. Patients regularly develop Cytokine Release Syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) after the transfusion of CAR T-cells. ⋯ The management of these patients requires an extensive diagnostic workup and complex treatment. An interdisciplinary team of hematologist, intensivist and others like neurologist and palliative medicine consultants is crucial for the best treatment of these patients. Together with the increasing number of patients this can lead to logistical issues for the intensive care departments of centers offering CAR T-cell therapies.